{"id":1625,"date":"2022-08-22T16:22:47","date_gmt":"2022-08-22T10:52:47","guid":{"rendered":"https:\/\/www.insurancesamadhan.com\/blog\/?p=1625"},"modified":"2022-11-17T10:21:05","modified_gmt":"2022-11-17T04:51:05","slug":"cashless-claims-in-health-insurance","status":"publish","type":"post","link":"http:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/","title":{"rendered":"Cashless claims in Health Insurance"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_76 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/#What_are_cashless_claims\" >What are cashless claims?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/#Can_a_cashless_claim_get_rejected_Why_do_they_get_rejected\" >Can a cashless claim get rejected? Why do they get rejected?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/#What_to_do_if_your_cashless_claim_gets_rejected\" >What to do if your cashless claim gets rejected?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/#Reimbursement\" >Reimbursement<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/#Here_is_a_similar_case_of_cashless_claim_rejection_resolved_by_Insurance_Samadhan\" >Here is a similar case of cashless claim rejection resolved by Insurance Samadhan<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/#Click_on_the_below_links_to_read_some_cases_resolved_by_Insurance_Samadhan\" >Click on the below links to read some cases resolved by Insurance Samadhan:<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n<h2 style=\"margin: 12.0pt 0cm 12.0pt 0cm;\"><span class=\"ez-toc-section\" id=\"What_are_cashless_claims\"><\/span><b><span style=\"font-size: 14.0pt; font-family: 'Arial','sans-serif'; color: black; background: white;\">What are cashless claims?<\/span><\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">All medical insurance promise cashless claim if treatment is taken in a network hospital. In cashless claims, your insurance company will directly settle your medical bills with the network hospital. You do not have to pay out of your pockets. You just have to inform your insurance company and take treatment from a network hospital as per the terms and conditions of your policy.<\/span><\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter size-full wp-image-1626\" src=\"https:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2022\/08\/Cashless-Claims-in-Health-Insurance2.jpg\" alt=\"Cashless Claims in Health Insurance\" width=\"1920\" height=\"1080\" srcset=\"http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2022\/08\/Cashless-Claims-in-Health-Insurance2.jpg 1920w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2022\/08\/Cashless-Claims-in-Health-Insurance2-300x169.jpg 300w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2022\/08\/Cashless-Claims-in-Health-Insurance2-1024x576.jpg 1024w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2022\/08\/Cashless-Claims-in-Health-Insurance2-150x84.jpg 150w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2022\/08\/Cashless-Claims-in-Health-Insurance2-768x432.jpg 768w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2022\/08\/Cashless-Claims-in-Health-Insurance2-1536x864.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Can_a_cashless_claim_get_rejected_Why_do_they_get_rejected\"><\/span><b>Can a cashless claim get rejected? Why do they get rejected?<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">You should know that even cashless claims can get rejected. The reason can be:<\/span><\/p>\n<ol>\n<li><b>Treatment taken from a non-network hospital<\/b><span style=\"font-weight: 400;\">: Cashless claim facility exists only when hospitalization and treatment were taken from a network hospital. It does not apply to the cases where you were admitted to a non-network hospital and taken the treatment from there itself. But you can ask for a reimbursement claim.<\/span><\/li>\n<li><b>Improper documents:<\/b><span style=\"font-weight: 400;\"> If the network hospital does not submit documents as per the agreed arrangement, your claim can get rejected. Mostly, network hospital has an understanding but sometimes casual approach is taken and proper documentation is not done.<\/span><\/li>\n<li><b>Undesired hospitalization<\/b><span style=\"font-weight: 400;\">: In many cases, patients and hospitals prefer taking treatment in hospitals just because of the insurance facilities. In cases, where it is proved that hospitalization was not desired, a claim can be denied.<\/span><\/li>\n<li><b>Non-disclosure of facts: <\/b><span style=\"font-weight: 400;\">Concealment or false disclosure of information might lead to claim rejection.<\/span><\/li>\n<li><b>Failed to take prior approval<\/b><span style=\"font-weight: 400;\">: You need to take an advance approval for a cashless claim. <a href=\"https:\/\/www.insurancesamadhan.com\/blog\/how-to-deal-with-health-insurance-claim-rejection\/\">The claim will be rejected<\/a> if approval was not taken.\u00a0<\/span><\/li>\n<li><b>Failed to update details<\/b><span style=\"font-weight: 400;\">: If you fail to update your contact details like address, phone number and e-mail, then your claim might get rejected.<\/span><\/li>\n<\/ol>\n<h2><span class=\"ez-toc-section\" id=\"What_to_do_if_your_cashless_claim_gets_rejected\"><\/span><b>What to do if your cashless claim gets rejected?<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If your health insurance cashless claim gets rejected and you feel that your claim is genuine then you can apply for a reimbursement.<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Reimbursement\"><\/span><b>Reimbursement<\/b><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">In <a href=\"https:\/\/www.insurancesamadhan.com\/blog\/procedures-of-availing-reimbursement-claim-of-your-health-insurance\/\">reimbursement<\/a>, the insured pays all the medical bills and other costs involved with hospitalization and treatment from his pocket and then applies for a claim from his insurance company. The insurance company will investigate the case. It will verify the medical reports and details of the bills and then decide whether to approve the medical reimbursement claim or reject it. If they reject it, they will notify you of the reason for rejection.<\/span><\/p>\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=organic&amp;utm_medium=blog&amp;utm_campaign=blog_post&amp;utm_term=blog_term\"><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/stage.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Insurance Samadhan\" width=\"500\" height=\"70\" border=\"0\" \/><\/a><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Here_is_a_similar_case_of_cashless_claim_rejection_resolved_by_Insurance_Samadhan\"><\/span><b>Here is a similar case of cashless claim rejection resolved by Insurance Samadhan<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Miss Sandeepa bought a health insurance policy for her parents in 2020. In January 2022, her father experienced chest pain and was breathless. They visited the hospital for a check-up. The initial ECG showed some deviations and an echo showed an LVEF of 35%. He was diagnosed with CAD-DVD and admitted to the hospital.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Miss. Sandeepa applied for a cashless claim, but the claim was rejected based on some doubts about hypertension. She stated that his father had no episode of hypertension in the past.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">She paid for the treatment from his pocket and applied for a reimbursement claim. She submitted all the documents for review, but the reimbursement claim was rejected. For over 5 months, she <\/span><span style=\"font-weight: 400;\">had an email trail with the insurance company, but nothing happened. She lost all her hopes.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Then, she learned about Insurance Samadhan and reached out to us on March 21, 2022. We took her father\u2019s case after understanding and verifying every detail of the case. She found us supportive and helpful. We helped her with every step of the procedure. By July 04, 2022, we were able to resolve her case and get the reimbursement money.\u00a0<\/span><\/p>\n<p><center><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/n0XNK0WImrE\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/center><span style=\"font-weight: 400;\">This case is one among 14,500 complaints that Insurance Samadhan has resolved so far over the last 4 years.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you have any complaints related to insurance, we\u2019ll be happy to give you our guidance.\u00a0<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Click_on_the_below_links_to_read_some_cases_resolved_by_Insurance_Samadhan\"><\/span>Click on the below links to read some cases resolved by Insurance Samadhan:<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/blog\/5-reasons-why-health-insurance-claims-get-rejected-amid-covid-19\/\">Health Claim Rejection amid Covid-19<\/a><\/p>\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/blog\/a-guide-for-a-life-insurance-lapsed-policy\/\">Mis-selling in a life insurance policy<\/a><\/p>\n<div>\n<div class=\"centered-text-area\">\n<div class=\"centered-text\">\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/blog\/top-5-reasons-for-death-claim-rejection\/\">Death Claim Rejection<\/a><\/p>\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=organic&amp;utm_medium=blog&amp;utm_campaign=blog_post&amp;utm_term=blog_term\"><strong>Click here<\/strong><\/a>\u00a0to register your complaint with Insurance Samadhan<\/p>\n<p style=\"background: white; margin: 0cm 0cm 7.5pt 0cm;\"><span style=\"font-family: 'Arial',sans-serif; color: #333333;\">You can also<\/span><\/p>\n<p style=\"background: white; margin: 0cm 0cm 7.5pt 0cm;\"><span style=\"font-family: 'Arial',sans-serif; color: #333333;\">Visit our website:\u00a0<a style=\"outline: none; transition: all 0.14s ease 0s;\" href=\"https:\/\/www.insurancesamadhan.com\/\"><span style=\"color: #ff2828;\">insurancesamadhan.com<\/span><\/a><\/span><\/p>\n<p style=\"background: white; font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; text-align: start; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; word-spacing: 0px; margin: 0cm 0cm 7.5pt 0cm;\"><span style=\"font-family: 'Arial',sans-serif; color: #333333;\">Call us on +91 9513631312<\/span><\/p>\n<p style=\"background: white; font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; text-align: start; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; word-spacing: 0px; margin: 0cm 0cm 7.5pt 0cm;\"><span style=\"font-family: 'Arial',sans-serif; color: #333333;\">WhatsApp:\u00a0<a style=\"outline: none; transition: all 0.14s ease 0s;\" href=\"https:\/\/api.whatsapp.com\/send?phone=+919910998252&amp;text=Hi\"><span style=\"color: #ff2828;\">\u00a09910998252<\/span><\/a><\/span><\/p>\n<p style=\"background: white; font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; text-align: start; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; word-spacing: 0px; margin: 0cm 0cm 7.5pt 0cm;\"><span style=\"font-family: 'Arial',sans-serif; color: #333333;\">Mail us at\u00a0<a style=\"outline: none; transition: all 0.14s ease 0s;\" href=\"mailto:corporate@insurancesamadhan.com\"><span style=\"color: #ff2828;\">corporate@insurancesamadhan.com<\/span><\/a><\/span><\/p>\n<p style=\"background: white; margin: 0cm 0cm 7.5pt 0cm;\"><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=organic&amp;utm_medium=blog&amp;utm_campaign=blog_post&amp;utm_term=blog_term\"><span style=\"font-family: 'Arial',sans-serif; color: #ff2828; background: white; text-decoration: none; text-underline: none;\">Click here<\/span><\/a><span style=\"font-family: 'Arial',sans-serif; color: #333333; background: white;\"><span style=\"font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; text-align: start; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; word-spacing: 0px;\">\u00a0to register your case with us<\/span><\/span><\/p>\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=organic&amp;utm_medium=blog&amp;utm_campaign=blog_post&amp;utm_term=blog_term\"><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/stage.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Insurance Samadhan\" width=\"500\" height=\"70\" border=\"0\" \/><\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<p><script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\/\",\n  \"@type\": \"Article\",\n  \"mainEntityOfPage\": {\n    \"@type\": \"WebPage\",\n    \"@id\": \"https:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/\"\n  },\n  \"headline\": \"Cashless claims in Health Insurance\",\n  \"description\": \"All medical insurance promise cashless claim if treatment is taken in a network hospital. In cashless claims, your insurance company will directly settle your medical bills with the network hospital. You do not have to pay out of your pockets. You just have to inform your insurance company and take treatment from a network hospital as per the terms and conditions of your policy.\",\n  \"image\": {\n    \"@type\": \"ImageObject\",\n    \"url\": \"https:\/\/i0.wp.com\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2022\/08\/Cashless-Claims-in-Health-Insurance2.jpg?resize=768%2C432&ssl=1\",\n    \"width\": \"1920\",\n    \"height\": \"1080\"\n  },\n  \"author\": {\n    \"@type\": \"Person\",\n    \"name\": \"Shailesh Kumar\"\n  },\n  \"publisher\": {\n    \"@type\": \"Organization\",\n    \"name\": \"Insurance Samadhan\",\n    \"logo\": {\n      \"@type\": \"ImageObject\",\n      \"url\": \"https:\/\/insurancesamadhan.com\/images\/logo.svg\",\n      \"width\": \"224\",\n      \"height\": \"47\"\n    }\n  },\n  \"datePublished\": \"2022-08-22\",\n  \"dateModified\": \"2022-08-22\"\n}\n<\/script><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What are cashless claims? All medical insurance promise cashless claim if treatment is taken in a network hospital. In cashless claims, your insurance company will directly settle your medical bills with the network hospital. You do not have to pay&hellip; <a href=\"http:\/\/www.insurancesamadhan.com\/blog\/cashless-claims-in-health-insurance\/\" class=\"more-link\">Continue Reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":1628,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[3],"tags":[89,90,83,84,93,92,25,87,91,65,85,88,86],"class_list":["post-1625","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-insurance","tag-cashless-claim","tag-cashless-claim-rejected","tag-cashless-claims","tag-cashless-claims-in-health-insurance","tag-claims-in-network-hospital","tag-claims-in-non-network-hospital","tag-health-insurance-claim","tag-medical-reimbursement","tag-network-hospital","tag-ppn-hospital","tag-reimbursement","tag-reimbursement-claim","tag-reimbursement-in-health-insurance"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - 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All medical insurance promise cashless claim if treatment is taken in a network hospital. In cashless claims, your insurance company will directly settle your medical bills with the network hospital. You do not have to pay&hellip; Continue Reading &rarr;","amp_enabled":true,"_links":{"self":[{"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/posts\/1625","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/comments?post=1625"}],"version-history":[{"count":6,"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/posts\/1625\/revisions"}],"predecessor-version":[{"id":2693,"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/posts\/1625\/revisions\/2693"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/media\/1628"}],"wp:attachment":[{"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/media?parent=1625"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/categories?post=1625"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.insurancesamadhan.com\/blog\/wp-json\/wp\/v2\/tags?post=1625"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}